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21 Gateway Corners Park Ste 101 Columbia SC 29203-8906 | |
(803) 865-2122 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 21 Gateway Corners Park Ste 101, Columbia, South Carolina |
Authorized Official Name and Position | Carole Cherny (SENIOR CREDENTIALING ANALYST) |
Authorized Official Contact | 8039367679 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 896239 Charlotte NC 28289-6239 Ph: (803) 865-2122 | 21 Gateway Corners Park Ste 101 Columbia SC 29203-8906 Ph: (803) 865-2122 |
NPI Number | 1407336076 |
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Provider Enumeration Date | 08/14/2018 |
Last Update Date | 08/14/2018 |
Identifier | Type | State | Issuer |
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1407336076 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
Lagniappe Medical Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74 Polo Rd, Columbia, SC 29223 Phone: 803-419-7780 Fax: 803-419-7781 | |